| NPI | 1770566002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 36831) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: CA 36831) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2025-09-11 |